Developing, Implementing, and Pilot Testing an Informed Decision Aid for Opioid Agonist Therapies for Prisoners in Ukraine

为乌克兰囚犯开发、实施和试点测试阿片类药物激动剂疗法的知情决策辅助工具

• 批准号: 10531558
• 负责人: Daniel J Bromberg
• 金额: $ 4.77万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-16 至 2024-01-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10531558
• 关键词: AIDS prevention; Address; Adopted; Adoption; Asian; Attitude; Behavior; Benefits and Risks; Buprenorphine; Caring; Central Asia; Cessation of life; Characteristics; Data; Decision Aid; Decision Making; Development; Eastern Europe; Effectiveness; Elements; Employment; Ensure; Environment; Epidemic; Equipment; European; Evidence based intervention; Evidence based practice; HIV; HIV/HCV; Health; Healthcare; Hepatitis C; Hepatitis C Transmission; Imprisonment; Influentials; Injecting drug user; Injections; Link; Mathematics; Mentorship; Methadone; Methods; Misinformation; Modeling; Overdose; Patient Preferences; Patients; Pharmaceutical Preparations; Pilot Projects; Positioning Attribute; Prevalence; Prevention strategy; Prisoner; Prisons; Process; Provider; Psychology; Relapse; Research; Resources; Risk; Structure; Subgroup; System; Testing; Training; USSR; Ukraine; Universities; addiction; career; contextual factors; data modeling; design; effective intervention; effectiveness evaluation; evidence base; experience; heuristics; high risk; implementation science; implementation strategy; implementation tool; mathematical model; opioid agonist therapy; opioid use disorder; pilot test; preference; pressure; relapse prevention; scale up; side effect; social; theories; tool; transmission process; uptake

Project Summary/Abstract The Eastern European and Central Asian (EECA) region has the most rapidly growing HIV epidemic world-wide, compounded by high rates of incarceration and drug injection. People who inject drugs (PWID) are concentrated in prisons, a region with some of the highest rates of incarceration, where 70% of PWID experience lifetime incarceration and 36% pass through prisons annually. Opioid agonist therapies (OAT) with methadone or buprenorphine are evidence- based practices (EBPs) that effectively reduce HIV and HCV transmission in PWID by 54% and 61%, respectively, and reduce death 3-fold. An OAT pilot of 38 prisoners started in Ukrainian prisons in 2020, yet coverage and scale-up in prisons is low in EECA and modeling data from Ukraine suggests that not only must coverage markedly increase in prisons, but PWID must be retained on it post-release. The prison environment, however, influences decisions about OAT due to within-prison contextual factors alongside misperceptions that incarceration is treatment. Informed decision-making aids are evidence-based tools that may facilitate OAT implementation and scale-up in prisons as they guide PWID in deciding whether or not to adopt OAT and what to choose based on personal preferences. The proposed research seeks to understand the treatment preferences of incarcerated PWID in Ukraine, adapt an informed decision-making aid to these preferences and context, pilot test this aid, and build a mathematical model showing how scale-up of the aid would impact HIV and HCV transmission over a 10-year horizon. I propose to: 1) Use conjoint-based choice with segmentation analysis with 600 prisoners with opioid use disorder to understand the OAT preferences of prisoners with opioid use disorder in Ukraine. These findings will guide adaptation of the informed decision-making aid where I will 2) systematically adapt an existing informed decision-making aid for opioid use disorder to the Ukrainian prison context by alpha and beta testing the adapted interactive protype with prisoners (n=25) and providers (n=10), and assess the utility of this implementation tool in changing decisions about OAT using a pre/post design pilot study (n=100); and 3) assess the effectiveness of this informed decision-making aid to scale-up OAT in prisons and its hypothetical impact on HIV and HCV transmission over a 10-year horizon in PWID in Ukraine, using a Markov-based dynamic state-transition model. These findings, if the informed decision-making aid influences OAT scale-up, can be used to guide adoption of this implementation strategy throughout Eastern European and Central Asian prisons, which have similar structures due to vestiges of the prison system of the former Soviet Union.

项目概要/摘要 东欧和中亚 (EECA) 地区是艾滋病毒增长最快的地区 该病在世界范围内流行，而且监禁率和注射毒品率很高。那些人 注射吸毒者（PWID）集中在监狱，该地区是吸毒率最高的地区之一 监禁，其中 70% 的吸毒者经历过终身监禁，36% 则通过 每年监狱。使用美沙酮或丁丙诺啡的阿片类激动剂疗法 (OAT) 是证据- 基于实践（EBP），可有效地将吸毒者中艾滋病毒和丙型肝炎病毒的传播减少 54% 分别为 61% 和死亡人数减少 3 倍。一项由 38 名囚犯组成的 OAT 试点项目以乌克兰语开始 到 2020 年，监狱的覆盖率和规模在 EECA 和建模数据中都较低 乌克兰建议，不仅监狱的覆盖率必须显着增加，而且吸毒者也必须 发布后保留在其上。然而，监狱环境会影响 OAT 的决定 由于监狱内的背景因素以及将监禁视为治疗的误解。 知情决策辅助是基于证据的工具，可以促进 OAT 的实施 并在监狱中扩大规模，指导注射吸毒者决定是否采用 OAT 以及采取什么措施 根据个人喜好选择。拟议的研究旨在了解 乌克兰被监禁的吸毒者的治疗偏好，调整知情决策援助 根据这些偏好和背景，对这种援助进行试点测试，并建立一个数学模型来展示如何 扩大援助规模将在十年内影响艾滋病毒和丙肝病毒的传播。我建议： 1) 对 600 名使用阿片类药物的囚犯使用基于联合的选择和分段分析 了解乌克兰患有阿片类药物使用障碍的囚犯的 OAT 偏好。 这些发现将指导我将 2) 的知情决策援助的调整 系统地调整现有的阿片类药物使用障碍知情决策援助，以适应 乌克兰监狱环境，通过与囚犯对改编后的互动原型进行阿尔法和贝塔测试 (n=25) 和提供商 (n=10)，并评估该实施工具在改变 使用设计前/设计后试点研究做出有关 OAT 的决定 (n=100)； 3）评估有效性 扩大监狱中 OAT 的知情决策援助及其对 使用基于马尔可夫的模型，了解乌克兰吸毒者 10 年内的 HIV 和 HCV 传播情况 动态状态转换模型。这些发现如果知情决策援助影响 OAT 规模扩大，可用于指导整个东部地区采用这一实施战略 欧洲和中亚的监狱，由于监狱遗迹，结构相似 前苏联的制度。

项目成果

Centering Young People's Perspectives, Needs, and Preferences in Research Regarding Barriers to Medications for Opioid Use Disorder-Reply.

• DOI: 10.1001/jamapediatrics.2022.0474
• 发表时间: 2022-06-01
• 期刊: JAMA PEDIATRICS
• 影响因子: 26.1
• 作者: Pilarinos, Andreas;Bromberg, Daniel J.;Karamouzian, Mohammad
• 通讯作者: Karamouzian, Mohammad

HIV, substance use, and mental health care in prisons.

• DOI: 10.1016/s2215-0366(22)00243-7
• 发表时间: 2022-09
• 期刊: LANCET PSYCHIATRY
• 影响因子: 64.3
• 作者: Fazel, Seena;Bromberg, Daniel J.;Altice, Frederick L.
• 通讯作者: Altice, Frederick L.